[Serial assessment of the nutritional status of patients infected by the human immunodeficiency virus. Role of tumor necrosis factor/its receptors]. / Valoración seriada del estado nutricional de enfermos infectados por el virus de la inmunodeficiencia humana. Papel del sistema factor de necrosis tumoral/receptores del mismo.

In order to analyze the nutritional status of HIV infected patients and the involvement of the tumour necrosis factor-alpha (TNF-alpha) and its soluble receptors (sTNFRI and sTNFRII) in such an status, forty HIV infected patients, with no associated systemic opportunist infections, were prospectively followed for eight months. From each patient the following were obtained: clinical history, dietetic survey, anthropometric measurements, CD4+ T lymphocyte/mm3 count, HIV load, and serum concentration of TNF and sTNFRI and sTNFRII. Patients showed a nutritional disorder which involved mainly the fat compartment (mean tricipital skin fold 9.8 +/- 4.2 mm, that is, 65.7 +/- 27.4% of the ideal fold), associated with a hypocaloric intake (mean daily intake 1,659.5 +/- 543.0 kcal), with normal proportions of the different organic principles. Serum concentrations of TNF (87.9 +/- 79.2 vs 8.7 +/- 6.1 pg/ml, p = 0.048) and its receptors, sTNFRI (6.1 +/- 2.6 vs 1.0 +/- 0.8 pg/ml, p < 0.001) and sTNFRII (41.9 +/- 18.6 vs 6.3 +/- 3.6 pg/ml, p < 0.001) were significantly higher than those detected in a sample of ten healthy controls. No correlation was found between nutritional alterations and concentrations of TNF or its receptors, viral load, and counts of CD4+ T lymphocytes/mm3. Seventeen patients completed the follow-up period. During this period, no significant modifications in the analyzed parameters were observed: tricipital skin fold, arm circumference, serum concentrations of albumin or transferrin, concentrations of tumoral necrosis factor or its receptor and caloric intake. The conclusion is that, despite the detected nutritional alterations in the nutritional status and those in the TNF/receptor system, our data no support and interrelationship between them.

[Clinical characteristicsand course of extrapulmonary/disseminated tuberculosis in patients with AIDS. Study of 103 cases diagnosed in the province of Cadiz]. / Características clínicas y evolutivas de la tuberculosis extrapulmonar/diseminada en los pacientes con SIDA. Estudio de 103 casos diagnosticados en la provincia de Cádiz.

Tuberculosis constitutes a public health problem that has become more serious in the past couple of years primarily due to the pandemic of human immunodeficiency virus (HIV). This study analyzes the evolutionary, clinical, and epidemiological characteristics of the extrapulmonary and disseminated forms of tuberculosis (TBD/E) in AIDS patients diagnosed in the province of Cádiz. Data for 103 patients who manifested both diseases were gathered prospectively. The prevalence of TBD/E was 30 percent among patients with AIDS. The primary risk factor was addiction to parenteral drugs (91 percent). Seventy-five percent of the patients were diagnosed with disseminated forms of the illness and 25 percent with extrapulmonary forms. The organs affected tended to be lymphatic ganglions and the lungs. Worthy of note is the lateness in seeking medical attention (45.6 +/- 4.5 days; range: 4-240 days). We conclude that tuberculosis constitutes a common pathology with an appreciable mortality in AIDs patients. Disseminated forms of tuberculosis predominate and may adopt a wide range of clinical manifestations. The lateness with which patients seek medical attention is a fact worth emphasizing.

[Treatment of hyperthyroidism from Graves-Basedow's disease]. / Tratamiento del hipertiroidismo por enfermedad de Graves-Basedow.

The Graves's Disease is the most frequent cause of hyperthyroidism. Currently, there is a lack of consensus with respect to the therapeutical role played by synthetic antithyroids, radioactive iodine and surgery. In order to study in depth this issue, we have analyzed the results of the therapy administered to 217 patients with Graves's Disease: 96 were treated with synthetical anti-thyroids, 46 with surgery and 75 with radioactive iodine. After twelve months of therapy with synthetic antithyroids, remission of the disease was observed in 64 patients (67%); the only factor predicting such remission was the absence of ophthalmopathy (p < 0.05); all 64 patients were followed-up during 12 months, detecting the recurrence of hyperthyroidism in 33 of them. Such recurrence is predicted by the serum levels of thyroid hormones before the administration of the therapy (p < 0.001). On the contrary, in patients treated with surgery or radioactive iodine, hyperthyroidism was controlled in 91% and 100% of them, respectively. Given the evolution of patients with Graves's Disease treated with synthetic antithyroids, we suggest the use of a more aggressive approach for the management of these patients.

[Nocardiosis in a patient with AIDS]. / Nocardiosis en paciente con SIDA.

A young drug addict with positive anti-HIV antibodies, OKT4/OKT8 ratio below 1, oropharingeal candidiasis and pulmonary Pneumocystis carinii infection, dies due to a cerebral abscess with a septic status. The postmortem microbiologic study shows pulmonary abscesses and Nocardia asteroides is isolated from lung tissue and spinal fluid. We note out the rareness of this pathology and its relation to AIDS.